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General NPI Number Information
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NPI Number | 1538645155
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Entity Type | Organization
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Legal Business Name | DRAGONFLY SUPPORT SERVICES, LLC.
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 1105 W IRONWOOD DR LOWR LEVEL
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2613
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Country | US
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Telephone | 208-676-1075
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 207
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City | POST FALLS
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State | ID
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Zip | 83877-0207
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BAILEY J WHITE
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Credential | LCSW
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Telephone | 208-691-1251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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